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Rheumatology > lupus > Flashcards

lupus Flashcards

1
Q

anti-dsDNA

A

high titers are SLE-specific and in some patients correlate with disease activity, nephritis, vasculitis

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2
Q

anti-Sm

A

specific for SLE, no definite clinical correlations; most pts also have anti-RNP, more common in blacks and asians than whites

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3
Q

anti-histone

A

more frequent in drug-induced lupus than in SLE

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4
Q

anti-phospholipid

A

three tests available: ELISAs or cardiolipin and B2G1, sensitive prothrombin time; predisposes to clotting, fetal loss, thrombocytopenia

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5
Q

diagnostic criteria for lupus

A

malar rash,, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, anti-nuclear antibiotics
if >= 4, specificity is 95%

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6
Q

MSK manifestations of SLE

A

arthralgias/myalgias, nonerosive polyarthritis, hand deforrmities, myopathy/myositis, ischemic necrosis of bone

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7
Q

cutaneous manifestations of lupus

A

photosensitivity, malar rash, oral ulcers, alopecia, discoid rash, vasculitis rash

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8
Q

renal manifestations of lupus

A

nephritis usually most serious (nephritis + infection leading causes of mortality)

  • proteinuria, hematuria, diffuse proliferative glomerulonephritis (DPGN)
  • nephrotic syndrome, HTN
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9
Q

what to do when someone is diagnosed with lupus

A

UA

renal biopsy to plan current and future therapies

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10
Q

neurologic manifestations of lupus

A

cognitive disorder, mood disorder, headache, seizures, mono or polyneuropathy, stroke / TIA, acute confusional state or movement disorder, aseptic meningitis, myelopathy

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11
Q

for neurologic symptoms caused by lupus, what needs to be figured out?

A

if symptoms are caused by a diffuse process (requiring immunosuppression) r vascular occlusive disease (requiring anticoagulation)

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12
Q

ANA

A

best screening test for SLE; repeated negative tests make SLE unlikely

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13
Q

vascular manifestations of lupus

A

increased TIA, stroke, and MI
anti-phospholipid ass. w/ hypercoaguability and acute thrombotic events
chronic disease w/ accelerated atherosclerosis

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14
Q

how can a lupus pt get brain ischemia?

A

focal occlusion (either noninflammatory or ass. w/ vasculitis) or by embolization from carotid artery plaque or from fibrinous veggies of Libman-Sacks endocarditis

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15
Q

how to treat vascular event in lupus?

A

if likely from clotting, use long term anticoagulation

if both vasculitis and vascular occlusion, anticoagulation and immunosuppression

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16
Q

pulmonary manifestations of lupus

A

pleuritis w/ or w/o pleural effusion (usually responds to NSAIDs and steroids)
also, pulmonary infiltrates, interstitial inflammation leading to fibrosis, shrinking lung sundrome, and intra-alveolar hemorrhage

17
Q

cardiac manifestations of lupus

A

pericarditis
also, myocarditis and fibrinous endocarditis of Libman-Sacks –> valvular insufficiencies
MI

18
Q

hematologic manifestations of lupus

A

anemia of chronic disease

hemolytic anemia, leukopenia and thrombocytopenia all responsive to steroids

19
Q

GI manifestations of lupus

A

flare –> n/v/d
autoimmune peritonitis
intestinal vasculitis can lead to perforations, ischemia, bleeding and sepsis

20
Q

ocular manifestations of lupus

A

sicca syndrome / Sjögren’s syndrome
conjunctivitis
serious: retinal vasculitis and optic neuritis

21
Q

tests for following lupus disease course

A

UA (hematuria, proteinuria), hemoglobin, platelets, creatinine, albumin

22
Q

conservative therapies for mgmt of non-life threatening lupus

A

analgesics and antimalarials
analgesics = usually NSAIDs
antimalarials = hydroxychloroquine, chloroquine, and quinacrine
if inadequate: may add steroids, mycophenolate mofetil, belimumab, azathioprine, methotrexate

23
Q

how to manage dermatitis from lupus

A

topical sunscreen, anti-malarials, and topical steroids and/or tacrolimus

24
Q

mgmt for life-threatening lupus (proliferative forms of lupus nephritis)

A

steroids + either cyclophosphamide or mycophenolate mofetil, perhaps also azathioprine

25
Q

pulmonary manifestations of lupus

A

pleuritis w/ or w/o pleural effusion (usually responds to NSAIDs and steroids)
also, pulmonary infiltrates, interstitial inflammation leading to fibrosis, shrinking lung sundrome, and intra-alveolar hemorrhage

26
Q

cardiac manifestations of lupus

A

pericarditis
also, myocarditis and fibrinous endocarditis of Libman-Sacks –> valvular insufficiencies
MI

27
Q

hematologic manifestations of lupus

A

anemia of chronic disease

hemolytic anemia, leukopenia and thrombocytopenia all responsive to steroids

28
Q

GI manifestations of lupus

A

flare –> n/v/d
autoimmune peritonitis
intestinal vasculitis can lead to perforations, ischemia, bleeding and sepsis

29
Q

ocular manifestations of lupus

A

sicca syndrome / Sjögren’s syndrome
conjunctivitis
serious: retinal vasculitis and optic neuritis

30
Q

tests for following lupus disease course

A

UA (hematuria, proteinuria), hemoglobin, platelets, creatinine, albumin

31
Q

conservative therapies for mgmt of non-life threatening lupus

A

analgesics and antimalarials
analgesics = usually NSAIDs
antimalarials = hydroxychloroquine, chloroquine, and quinacrine
if inadequate: may add steroids, mycophenolate mofetil, belimumab, azathioprine, methotrexate

32
Q

how to manage dermatitis from lupus

A

topical sunscreen, anti-malarials, and topical steroids and/or tacrolimus

33
Q

mgmt for life-threatening lupus (proliferative forms of lupus nephritis)

A

steroids + either cyclophosphamide or mycophenolate mofetil, perhaps also azathioprine

Rheumatology (10 decks)

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